Test 20 - IM

Question 1

How do you treat asymptomatic gallstones?

Answer 1

You don’t

Question 2

Patient has splenomegaly and is itchy when they get out of the bath. What do they have?

Answer 2

Polycythemia Vera - increased number of circulating basophils cause histamine release when triggered by the hot temperature of the shower.

Question 3

Why do people with polycythemia vera get gout?

Answer 3

Polycythemia vera causes an increased catabolism of purines which can lead to a build up of uric acid. Up to 40% of patients with polycythemia vera have gout.

Question 4

What are the ECG signs of left ventricular hypertrophy? (3)

Answer 4

1. High QRS complexes
2. Downsloping ST-segment depression
3. T-wave inversion (in leads V5-V6)

Question 5

According to the guidelines, all patients with severe symptomatic hypertension (especially young patients) should be evaluated for what?

Answer 5

Coarctation of the aorta

Question 6

What do you seen on CXR if someone has a coarctation?

Answer 6

Notching of the 3rd-8th ribs due to enlarged intercostal arteries

Question 7

Signs of late onset aortic coarctation

Answer 7

hypertension in an otherwise young healthy person

• chest pain
• claudication
• headaches
• epistaxis
• heart failure
• possibly even aortic dissection in severe cases

Question 8

Coarctation physical exam

Answer 8

1. Brachial- femoral delay on palpation
2. Upper extremity HTN, lower extremity HOTN
3. Continuous murmor from large collaterals

Question 9

Coarctation Diagnostic Studies (3)

Answer 9

ECG: LVH
CXR: notching and “3” sign of aortic indentation
Echo: normal

Question 10

Coarctation trt

Answer 10

Balloon angioplasty

Question 11

What is a normal ESR?

Answer 11

1-25 mm/h

Question 12

What are the distinguishing clinical features in Fibromyalgia vs Polymyositis v Polymyalgia Rheumatica?

Answer 12

FM: Young to middle aged women, muscle PAIN but not weakness, both sides of body, above and below waist, cognitive difficulties, fatigue

PM: symmetric proximal muscle WEAKNESS, difficulty climbing stairs, getting up from chair, carrying heavy groceries

PMR: usually over 50, pain worse in the morning, synovitis, bursitis, decreased range of motion, no tenderness.

Question 13

What are the distinguishing laboratory features in Fibromyalgia vs Polymyositis v Polymyalgia Rheumatica?

Answer 13

FM: labs normal, symptoms less than 3 months with rapidly increasing symptom severity

PM: Elevated MUSCLE ENZYMES ( Creatine kinase, aldolase, lactate dehydrogenase, aspartate aminotransferase). Possible autoantibodies.

PMR: ELEVATED ESR!!! Symptoms improve with corticosteroids.

Question 14

Why do patients with ankylosing spondylitis have decreased FEV and increased FRC?

Answer 14

Chronic inflammation of AS leads to fusion of the costovertebral joints resulting in restriction of motion of the chest wall. Joint fixes in the inspiratory position = increased FRC and decreased FEV

Question 15

Why do you give calcium gluconate?

Answer 15

To protect the heart in hyperkalemia

Question 16

When do you give magnesium sulfate?

Answer 16

When patient has torsades de pointe from a prolonged QT interval.

Question 17

Your patient comes in with CNS depression, hypotension, dilated pupils and hyperthermia. What is wrong? What do you do?

Answer 17

Anticholinergic overdose most likely. Give atropine and pralidoxime.

Question 18

Need to annotate questions 9 and 10 of this set.

Answer 18

a